Duntsch was convicted on the latter count in 2017 and was sentenced to life in prison.

That conviction came on behalf of Mary Efurd, a former patient who suffered terribly under the surgeon. In 2012, Duntsch performed surgery on the then-71-year-old, who had complained of back pain. After a badly botched surgery, Efurd awoke from surgery screaming in agony. She is now wheelchair bound, making her one of dozens of patients who alleges Duntsch mismanaged their surgery.

Duntsch appealed the sentence with the Texas Court of Appeals. On Tuesday, that court delivered a guilty verdict. Duntsch has now exhausted all appeals. He will spend the remainder of his life in prison.

Unlike the titular figure in Dirty John, John Meehan, who only pretends to be a doctor, Duntsch was a trained, licensed physician — but not a skilled one. The podcast explores not only how Duntsch’s incompetence and possible malice towards his patients (prosecutors during his trial alleged that he maimed his patience intentionally) put them in grave danger, but how those with power in the medical industry allegedly chose to protect Duntsch, and the system, instead of these victims.